German Health Minister Nina Warken of the ruling Christian Democrats (CDU) has unveiled a reform package intended to stabilise the country’s struggling public health insurance system and prevent further rises in contribution rates.
Warken’s draft legislation, expected to be approved by the cabinet this summer, is aimed at stopping increases to health insurance contributions. “We simply cannot spend more than we take in,” she said at a Berlin press conference.
Context and fiscal pressure
Health insurance is mandatory in Germany. About 90% of the population are insured under the income-dependent public system (Gesetzliche Krankenversicherung, GKV). Contributions total roughly 14.5% of income, split evenly between employer and employee, plus a small additional premium set by individual insurers.
Contributions rose on average by 3% this year, after a 2.5% rise in 2025, while insurers’ expenditures have climbed even faster. Without savings measures, public health funds face a projected shortfall of more than €15 billion by 2027.
Key measures announced
Warken said the government will implement several of 66 cost-cutting proposals put forward by an expert commission. Measures announced include:
– Prescription charges will rise to between €7.50 and €15 (up from €5 to €10).
– Mandatory second opinions will be required for costly hip and knee surgeries, to be provided by doctors who do not profit from the procedures.
– From 2028, spouses without their own income who are currently covered free will pay a flat rate equal to 3.5% of their partner’s income. The rate will be lower for low- and middle-income households and exemptions will apply for those caring for children under age seven, parents of children with disabilities, caregivers and pensioners.
– Homeopathy will no longer be reimbursed by statutory health insurance.
– Stronger mandatory discounts will be demanded from the pharmaceutical industry.
– New limits will be placed on fees for health insurance executives and on administrative and advertising expenditures.
– Extra-budgetary payments for family doctors for services such as walk-in consultation hours and payments tied to referred patients will be removed.
Political reaction
The Greens criticised the package as inadequate. Janosch Dahmen, the Green Party’s health policy spokesperson, said Warken was shifting too much of the burden onto employees and employers while failing to tackle powerful spending lobbies.
The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) welcomed Warken’s pledge to use revenue as a benchmark for insurers’ spending. The association noted statutory funds now spend over €1 billion per day on care for the roughly 75 million people covered. It added that, in the past year alone, hospital spending rose nearly 10%, doctors’ costs by almost 8%, and drug expenditures by about 6%.
Not included: welfare cost shift
The reform package does not include the commission’s largest single-saving recommendation: transferring the health insurance costs for welfare recipients to the federal budget. That change was estimated to save insurers about €12.5 billion in 2027. Warken appears to have conceded to pressure from Finance Minister Lars Klingbeil of the Social Democrats, who threatened to veto such a shift.
Next steps
The proposals will be turned into draft legislation to be approved by the cabinet at the end of April. Parliamentary votes are expected in the Bundestag and the Bundesrat, which represents Germany’s 16 federal states, before the summer recess.
Edited by: Rina Goldenberg
